Insurance Clearance Representative Senior

Advocate Aurora Health • Menomonee Falls, WI

277d • $22 - $33 • Remote

About The Position

The Insurance Clearance Representative Senior position at Advocate Health involves acquiring and maintaining knowledge of all payor requirements related to patient and hospital responsibilities for authorizations and hospital billing. This includes performing insurance authorization for inpatient and outpatient services by accurately collecting and analyzing clinical data in support of payor guidelines. The role requires consultation with patients regarding uninsured status, uncovered services, and out-of-network status, as well as managing incoming and outgoing calls for pre-registration. The representative must ensure accurate entry of patient demographic and insurance information and generate necessary documents for registration. Participation in department meetings and continuing education is also expected to maintain skill competency.

Requirements

• High School Graduate.
• Typically requires 2 years of experience in health care, insurance industry, call center, or customer service setting.
• Ability to problem solve in a high profile and high stress area.
• Ability to prioritize and organize workload.
• Mathematical aptitude, effective communication, and critical thinking skills.
• Understanding of basic human anatomy and medical terminology.
• Excellent verbal and written communication skills.
• General computer knowledge.

Responsibilities

• Acquire and maintain knowledge of all payor requirements related to authorizations and hospital billing.
• Perform insurance authorization for inpatient and outpatient services by collecting and analyzing clinical data.
• Consult with patients regarding uninsured status, uncovered services, and out-of-network status.
• Initiate communication with patients when authorization is not obtained and explain potential financial responsibilities.
• Maintain knowledge of software programs to verify eligibility and authorization.
• Ensure completion of policies and procedures for identification and notification of Primary Care Physician in HMO coverage cases.
• Identify at-risk balances related to Medicaid eligibility rules and communicate with relevant departments.
• Manage incoming and outgoing calls to complete pre-registration with patients.
• Pre-register and register patients using established procedures for computer entry.
• Generate and process required documents for registration and provide education to patients on necessary forms.
• Participate in department staff meetings and continuing education.
• Maintain confidentiality of patient records by following HIPAA and compliance policies.

Benefits

• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED